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Right Hip Labral Tear In A 22
Year-Old Collegiate Male
Ruby L. Floyd, ATS
Jill A. Manners, MS, MPT, LAT, ATC, PT
Western C...
Objective


To educate athletic trainers regarding the
evaluation of a unique presenting right hip
labral tear
Case Background



22 year-old collegiate male, recreational athlete
Previous medical history




Falling off a horse ...
Anatomical Review


Femoroacetabular Joint





Head of femur
Acetabulum

Joint Stability




Capsule
Ligaments
Ace...
Blood Supply


Blood Supply






Artery to the head of the
femur
Medial and lateral femoral
circumflex arteries

Avas...
Initial Clinical Evaluation


History


Complaints of:






Range of Motion




Passive Internal Rotation

Streng...
Differential Diagnosis









Snapping hip syndrome
Iliopsoas bursitis
Osteoarthritis
Femoral fracture
Avascular...
Physician Evaluation




Follow-up with orthopedist for further
evaluation
Diagnostic testing


Radiographs




MRI
...
Surgical Diagnosis


Arthroscopic
diagnosis




Tear of the superior
labrum
Synovitis

McDermott I. Acetabular Labral T...
Post–Surgical Rehabilitation


Immediate post surgical








Rest
Ambulate 50% PWB
Heel-toe gait pattern
Hip prec...
Continued Rehabilitation


3 months post surgical:





Strengthening
CKC proprioceptive exercises
Functional activit...
Outcome






Fully functional with all Activities of Daily
Living
No pain
No instability
Similar RTP timeline to a co...
Uniqueness of This Case


Mechanism of injury



Time lapse between initial onset and
surgical repair



Diagnostic ima...
MRIs
Standard MRI

Arthrogram MRI

Rakhra KA. Magnetic resonance imaging of acetabular labral tears. J Bone Joint Surg Am....
Relevance to Athletic Training




Evaluation and management
Full history
Accuracy of diagnostic images
References
1.

2.

3.

4.

5.

6.

The American Orthopaedic Society for Sports Medicine. Hip Arthroscopy.
2010. http://ort...
Acknowledgement


Thank you to:



MAATA Selection Committee
Jill Manners, Program Director/Faculty Advisor
Thank You!
Any
Questions?
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Right Hip Labral Tear in a 22 Year-Old Collegiate Male

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Right Hip Labral Tear in a 22 Year-Old Collegiate Male

  1. 1. Right Hip Labral Tear In A 22 Year-Old Collegiate Male Ruby L. Floyd, ATS Jill A. Manners, MS, MPT, LAT, ATC, PT Western Carolina University, Cullowhee, North Carolina
  2. 2. Objective  To educate athletic trainers regarding the evaluation of a unique presenting right hip labral tear
  3. 3. Case Background   22 year-old collegiate male, recreational athlete Previous medical history   Falling off a horse and being dragged by his right leg Current mechanism of injury:  Reaching forward in a seated position
  4. 4. Anatomical Review  Femoroacetabular Joint    Head of femur Acetabulum Joint Stability    Capsule Ligaments Acetabular labrum The American Orthopaedic Society for Sports Medicine. Hip Arthroscopy. 2010. http://orthoinfo.aaos.org/figures/A00571F01.jpg. Accessed March 7, 2012.
  5. 5. Blood Supply  Blood Supply    Artery to the head of the femur Medial and lateral femoral circumflex arteries Avascular Necrosis Ellis H and Mahadevan V. Clinical Anatomy: Applied Anatomy for Students and Junior Doctors.12th ed. West Sussex, UK: Wiley-Blackwell; 2010: 233.
  6. 6. Initial Clinical Evaluation  History  Complaints of:     Range of Motion   Passive Internal Rotation Strength Testing   Radiating pain Parethesia Night pain Hip Flexion Special Tests  Grind (Scouring) Test
  7. 7. Differential Diagnosis         Snapping hip syndrome Iliopsoas bursitis Osteoarthritis Femoral fracture Avascular necrosis of the femoral head Acetabular labral tear Hip subluxation Hip dislocation
  8. 8. Physician Evaluation   Follow-up with orthopedist for further evaluation Diagnostic testing  Radiographs   MRI   Negative Negative Diagnostic Arthroscopy
  9. 9. Surgical Diagnosis  Arthroscopic diagnosis   Tear of the superior labrum Synovitis McDermott I. Acetabular Labral Tears. Sports Orthopaedics UK. 2010. http://www.sportsortho.co.uk/article.asp?article=66. Accessed March 7, 2012.
  10. 10. Post–Surgical Rehabilitation  Immediate post surgical       Rest Ambulate 50% PWB Heel-toe gait pattern Hip precautions Strengthening 4 weeks post surgical   Weight bearing as tolerated AROM to end-range
  11. 11. Continued Rehabilitation  3 months post surgical:     Strengthening CKC proprioceptive exercises Functional activities Jogging progression
  12. 12. Outcome     Fully functional with all Activities of Daily Living No pain No instability Similar RTP timeline to a competitive athlete
  13. 13. Uniqueness of This Case  Mechanism of injury  Time lapse between initial onset and surgical repair  Diagnostic imaging Baber YF, Robinson AHN, Villar RN. Is diagnostic arthroscopy of the hip worthwhile? J Bone Joint Surg [Br] 1999; 81-B:600-603. http://web.jbjs.org.uk/content/81-B/4/600.full.pdf. Accessed March 7, 2012.
  14. 14. MRIs Standard MRI Arthrogram MRI Rakhra KA. Magnetic resonance imaging of acetabular labral tears. J Bone Joint Surg Am. 2011; 93(Supplement 2):28-34. doi:10.2106/jbjs.j.01722. Ziegert AJ, Blankenbaker DG, De Smet AA, Keene JS, Shinki K, Fine JP. Comparison of standard hip MR arthrographic imaging planes and sequences for detection of arthroscopically proven labral tear. AJR. 2009; 192:1397–1400. doi:10.2214/AJR.08.1609.
  15. 15. Relevance to Athletic Training    Evaluation and management Full history Accuracy of diagnostic images
  16. 16. References 1. 2. 3. 4. 5. 6. The American Orthopaedic Society for Sports Medicine. Hip Arthroscopy. 2010. http://orthoinfo.aaos.org/figures/A00571F01.jpg. Accessed March 7, 2012. Ellis H and Mahadevan V. Clinical Anatomy: Applied Anatomy for Students and Junior Doctors.12th ed. West Sussex, UK: Wiley-Blackwell; 2010: 233. McDermott I. Acetabular Labral Tears. Sports Orthopaedics UK. 2010. http://www.sportsortho.co.uk/article.asp?article=66. Accessed March 7, 2012. Baber YF, Robinson AHN, Villar RN. Is diagnostic arthroscopy of the hip worthwhile? J Bone Joint Surg [Br] 1999; 81-B:600-603. http://web.jbjs.org.uk/content/81-B/4/600.full.pdf. Accessed March 7, 2012. Rakhra KA. Magnetic resonance imaging of acetabular labral tears. J Bone Joint Surg Am. 2011; 93(Supplement 2):28-34. doi:10.2106/jbjs.j.01722. Ziegert AJ, Blankenbaker DG, De Smet AA, Keene JS, Shinki K, Fine JP. Comparison of standard hip MR arthrographic imaging planes and sequences for detection of arthroscopically proven labral tear. AJR. 2009; 192:1397– 1400. doi:10.2214/AJR.08.1609.
  17. 17. Acknowledgement  Thank you to:   MAATA Selection Committee Jill Manners, Program Director/Faculty Advisor
  18. 18. Thank You! Any Questions?

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